A cigarette first thing in the morning may light up the risk of lung and head and neck cancers, according to case-control study findings.

Action Points

Explain that a cigarette first thing in the morning may increase the risk of lung and head and neck cancers.

Note that the risk of lung cancer risk rose significantly with an earlier start in the day even after controlling for the number of cigarettes smoked per day.

A cigarette first thing in the morning may light up the risk of lung and head and neck cancers, according to case-control study findings.

Smokers who lit up within half an hour of waking up were at a 59% higher head and neck cancer risk and 79% elevated lung cancer risk compared with those who waited at least an hour, Joshua E. Muscat, PhD, of Penn State College of Medicine in Hershey, Penn., and colleagues found.

Those who started on their first cigarette 31 to 60 minutes after waking were at significantly elevated risk as well (42% and 31%, respectively), the group reported in two linked studies appearing online in Cancer.

While any smoking boosts cancer risks, an early start in the day might be particularly risky because it signals stronger nicotine dependence, the researchers suggested.

Thus, "smokers who smoke soon after waking may require special efforts to make them aware of their increased risk and the need for smoking cessation therapies," Muscat's group wrote.

They compared cancer risks similarly in two cohorts, reported separately.

One study described results among 1,055 head and neck cancer patients and 795 controls, all with a history of smoking cigarettes, seen at New York-area academic center hospitals.

Similar to the pack-years smoked adjusted results above, head and neck cancer risk followed time to first cigarette after adjustment for number of cigarettes smoked per day:

2.11-fold more likely with smoking within 30 minutes of waking (95% confidence interval 1.61 to 2.77)

1.63-fold more likely with a first cigarette within 31 to 60 minutes of waking (95% CI 1.18 to 2.26)

The other study described analysis of 4,775 newly-diagnosed lung cancer cases and 2,835 controls, all former or current cigarette smokers, seen at the same group of academic hospitals.

Current smoking and greater number of cigarettes smoked per day were linked to higher lung cancer risk.

As with the sociodemographic and pack-years adjusted risks noted at the outset, lung cancer risk controlling for number of cigarettes smoked per day rose significantly with an earlier start in the day: